Octreotide (Sandostatin®, Sandostatin LAR®)
Classification: Somatostatic Agent
About Octreotide (Sandostatin®, Sandostatin LAR®)
Octreotide is a hormone that occurs naturally in the body. It is used to treat carcinoid syndrome, which is seen in patients with carcinoid or neuroendocrine tumors. These tumors cause the body to overproduce certain hormones, and these hormones in turn can lead to symptoms collectively known as "carcinoid syndrome". Common symptoms include: flushing (90% of patients), diarrhea (75%), abdominal cramping (51%), and abnormalities of the heart valves (53%), possibly leading to right heart failure. Octreotide works to reduce the production of these hormones and thereby decrease the symptoms.
How to Take Octreotide
The short acting form of octreotide is given as a subcutaneous injection (injection under the skin) or in an intravenous (IV) form. The dosage is dependent on how your body responds and is given several times a day. For chronic treatment, patients typically receive the short acting form initially, and if this results in a decrease in their symptoms, switch to the long-acting form for convenience.
The long-acting formulation, Sandostatin LAR, is octreotide contained in "microspheres", which allow the drug to be slowly released into the body over a 4-week period. This allows the patient to receive only one injection a month at their doctor's office. This injection is given into the muscle (intramuscularly or IM). You may receive the short-acting form for several weeks after starting the LAR form while the LAR reaches therapeutic levels. Some patients may still use the short-acting form to control "breakthrough symptoms" (symptoms that may occur occasionally while on the LAR form).
This medication can interact with other medications, including cyclosporine, insulin, oral diabetic medications, and many cardiac mediations. Be sure to tell your healthcare provider about all medications and supplements you take.
Possible Side Effects of Octreotide
There are a number of things you can do to manage the side effects of Octreotide. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:
In studies, gallstones or billiary abnormalities (including jaundice) developed in more than half of patients after long- term usage. However, only 1% of patients required surgery to correct them.
Pain at the Injection Site
Pain, redness or swelling may occur at the injection site. This typically lasts less than 10-15 minutes after the short-acting form and an hour after the LAR form. To reduce this side effect, take the medication out of the refrigerator ahead of time and allow it to reach room temperature. Do not heat it or warm it rapidly. Also, rotating the site of the injections is helpful.
Abdominal Side Effects
Side effects such as diarrhea, bloating, gas, and abdominal pain were reported in studies. It is difficult to tell if these are related to the medication or the disease, so discuss them with your doctor or nurse. These side effects may be decreased by giving the injections between meals or at bedtime. The LAR form is less likely to cause these side effects, and they typically stop within 1-4 days of the injection and decrease with long-term treatment.
Nausea and/or Vomiting
Talk to your doctor or nurse so they can prescribe medications to help you manage nausea and vomiting. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms.
Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.
Your oncology team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods and absorbs fluid, which can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange sections, boiled potatoes, white rice, products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses on non-alcoholic, un-caffeinated fluid a day to prevent dehydration.
This medication can cause hypothyroidism (under active thyroid). Your doctor will perform blood tests to check the function of your thyroid and treat this side effect if it develops. Report any symptoms of thyroid problems including: tiredness, feeling hot or cold, change in your voice, weight gain or loss, hair loss and muscle cramps.
This medication may cause slow or abnormal heartbeats or sinus bradycardia. Notify your healthcare provider right away if you feel abnormal heartbeats or if you feel dizzy or faint.
Blood Sugar Changes (Hypo/Hyperglycemia)
This medication can cause lowered or elevated blood sugar levels in patients with and without diabetes. Your healthcare team will monitor your blood sugar. If you develop shakiness, nervousness, anxiety, sweating, chills, clamminess, rapid/fast heartbeat or headaches (symptoms of low blood sugar) or develop increased thirst, urination or hunger, blurry vision, headaches, or your breath smells like fruit (symptoms of high blood sugar) notify your healthcare team. Diabetics should monitor their blood sugar closely and report elevations to the healthcare team.